Amongst the many farsighted health reforms that the Patient Protection and Affordable Care Act of 2010 (PPACA) has floated is the concept of Accountable Care Organization (ACO).

Believed to be a cost-controlling measure on public health expenditure, ACO is a health care model that ensures healthcare providers incentives from the savings made on a pre-assigned group of patients. Therefore, it is mandatory that a consenting group of medical professionals - comprising physicians, specialists, and support staff - form an alliance that caters to comprehensive needs of the pre-assigned group of patients while also keeping the standard high. Thus, all along with having incentive to a portion of savings made from a strategic alliance, Accountable Care Organizations will also be under constant vigilance for quality.

Convinced with ACO's far-reaching benefits, many hospitals, physician practices and insurers across the U.S. are serious about forming their own ACOs much before its official launch in January 2012. What is still more interesting is they are in favor of extending ACOs - originally conceived for Medicare patients - to patients of private insurance as well.

Although there is an apprehension that propensity to consolidate healthcare services under ACOs lends undue advantage to large players to influence insurance carriers and eventually drive up healthcare costs, yet, given the controlling measures to put a seal on the quantum of healthcare operations by each ACO, it out-weighs demerits. Consequently, in addition to ensuring quality healthcare at minimum cost, ACO - with streamlined healthcare services - will also promote an efficient reporting system in compliance with HIPAA norms.

Significance of Medical Billers and Coders

Quite expectedly, the role of medical billers and coders will assume greater significance as they will also be required to map their services to ACO environment, wherein the quantum of billing tends to be usually large, but the fee is highly competitive. Presumably, medical billers and coders will be forced to consolidate into bigger entities to serve the comprehensive billing needs of these ACOs - accurate charge-capture, intricate procedure coding, and electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, and compliance standards of HIPAA. Medicalbillersandcoders.com (www.medicalbillersandcoders.com), the largest consortium of billers and coders in the U.S., is best poised to handle such a scenario, and assume the mantle of being the promoter of cost-effective billing services.

Thus, being an integral link in the healthcare system, medical billing and coding entities too will experience the impact of one of the important constituents of the Patient Protection and Affordable Care Act of 2010 (PPACA): Accountable Care Organization (ACO)

The importance of negotiating or renegotiating payer contracts has drastically grown after the recent health care reforms. This is because insurance companies are being reined in by the government and may see a decline in profits. This presents a good opportunity for payer contracts to become a source of income more for the insurance companies rather than for physicians. Therefore it has now become even more important for physicians to negotiate and renegotiate payer contracts and read the fine print. Moreover, it is apparent that you as a physician would gain experience as the contract progresses and would need increments in your reimbursements.

Many physicians do not bother to review and renegotiate their contracts and insurance companies also do the same since it is in their interests to do so. Private insurance companies usually have a tenure within which physicians must renegotiate their contracts or the contract is automatically renewed at the old rates. Furthermore, the technicalities and the complexity of payer contracts necessitates time and effort which many physicians cannot afford to dedicate due to a busy schedule. This is where the administrative role of medical billers and coders who are professionals in this area can be of immense importance.

Calculating the exact revenue or earnings that you receive from every patient visit and distributing them among the major plans such as Medicare or Medicaid can give you an idea of the qualitative time spent on such plans and patients. This way you can decide which insurance contracts need renegotiation. There are numerous other aspects such as meetings with insurance representatives, correspondence, and legalities involved in payer contracts that make it a job for professionals. Medical billers and coders who have experience in this area can not only renegotiate contracts which are better paying but also provide you with value added services such as credentialing with various payers among others.Analyzing and calculating reimbursement rates annually or periodically is also a crucial aspect of payer contracts.

With so many insurance providers, it becomes difficult as a physician to keep track of all the changes happening in the health care sector. Our medical billers and coders at medicalbillersandcoders.com have been in this business for so long that they are armed with up-to-date information about various payers and changes in the health industry. This can help you in increasing your revenue by as much as 10% and also relieve you of the effort taken for negotiating or renegotiating payer contracts. We also provide other value added services such as background assistance and credentialing for new practices and for business expansion.

Moreover, since negotiation of payer contracts is a long and periodic process it would make sense to hire professionals who are experienced in this area instead of putting in your own valuable time and effort. For more information on negotiating and renegotiation of payer contracts, please visit medicalbillersandcoders.com

Denial management is one of the crucial aspects for a physician and can assist in improving the revenue cycle management. This can not only reduce errors while managing claim denials but also help in increasing the physician's revenue. This process is carried out by medical billers and coders who have specialized knowledge in the field and are aware of its legal aspects. Efficient denial management can increase the revenue in numerous ways; some of which are obvious while others enhance the revenue in an indirect manner.Specialized medical billers and codersMedical billers who are experienced and specialized in this field can perform better by utilizing their skills with incisive understanding of why the claim was denied in the first place. Specialized billers also represent your case strongly when the claim is correctly filed and the payer denies the claim on unclear grounds. Denial ratios are steadily increasing with payers in the given healthcare scenario.AnalysisThe best way to speed up the process of denial management is to analyze the grounds on which the claims are denied. Once the reason for claim denial is known, it becomes easier for medical billers and coders to correct the error and receive the deserved reimbursement. In Denial Management, Root cause analysis is more important than re-filing the claim.Moreover, once the reasons for revenue leakage have been identified, any further loss can be pre-empted or stopped before it has occurred for the first time. Proactive Denial Management can increase the cash flow and the revenue by almost 10% by reducing the number of first-time claim denials.ExpertiseDenial management can involve communication with various entities and it is important to be trained in the process of collections from such entities. These involve recovering collectibles from any of the payers such as Medicare, Medicaid, BCBS, United Healthcare, Aetna and many local payers.AppealsA crucial part of claims denials is appeals and these are explanations for re-eligibility of the claim for payment which was denied earlier. Since these claims can only be appealed within a set period of time, it becomes important to prioritize them. Not every claim can be appealed thus this tool must be used judiciously. The Billing specialist must also possess the skill required to write appeal letters as the explanation with correction is what gets you paid in most cases.Prioritize Denials as per valueManaging denied claims or appealing them can be made cost effective by reviewing the most commonly denied claims according to the dollar value and volume. This helps in determining which claims should be given the most importance and which are less likely to produce positive results. This can assist in cutting costs as well as saving time in the revenue cycle management.Medical billing and coding specialists at medicalbillersandcoders.com are experienced in denial management and are skilled in other areas of medical billing and coding services such as charge entry, payment posting, credentialing, and managing accounts receivables.For further information and medical billing and coding services please visit medicalbillersandcoders.com. Austin Medical Billing, Baltimore Medical Billing, Birmingham Medical Billing

Practice Management Software (PMS) can be a powerful tool for physicians since it can optimize administrative and financial activities in order to directly increase revenue and save time. A flexible and efficient PMS allows billers and coders to view Remittance Advice Reports and Claim Payment Reports in addition to interpreting Electronic Remittance Advice from the government and insurance companies. This advice helps in making payments quicker by accelerating the billing process.Faster reimbursementPractice management software ensures faster remittance by speeding up the flow of information and eliminating the requirement of paper based records. This makes it easier for billers and coders to perform multiple tasks such as offer physicians various reports, account billing by day or by month, classify accounts receivables in day wise buckets, and insurance and patient collectibles statements.Low costIt is apparent that these various functions if performed by assistants, secretaries, accountants, or an IT staff. The cost effectiveness of the software and various free value added services make it ideal for keeping pace with the reforms in the healthcare IT sector.Advanced featuresAn EMR Integrated with the PMS is an advanced practice management solution to streamline processes such as accounts receivables and insurance and patient collectibles along with other functions such as appointment scheduling, verifying insurance information online, capturing patient demographics, tracking patient progress (by physician) and building performance reports. This solution can bring the entire practice on the same platform, bringing the practice owner in control.Quick and easy updatingMany software companies update the ICD and CPT codes on a regular basis and this helps in increasing the scope to cover critical areas such as family practice and ambulatory care. It also helps medical billers and coders in eliminating errors by avoiding the use of old redundant coding books.Supports all practice sizesAn average web based PMS requires merely a personal computer and an internet connection to work efficiently. This makes it easy for small to medium sized businesses to perform practice management tasks without investing unjustified time, labor and money in the process of setting up the Practice Management Software.For more information and services about Practice Management System and also updated medical billing and coding professionals you can visit medicalbillersandcoders.com, Milwaukee Medical Billing, New York City Medical Billing, Philadelphia Medical Billing.

WILMINGTON, Delaware, July 25, 2011 /PRNewswire/ -- Viewing the dynamic changes sweeping through the healthcare industry, MBC has perceived an urgent requirement of professional support and assistance to healthcare providers to adapt to the latest regulations and flux in the healthcare industry. MBC, armed with extensive multispecialty experience and expertise in billing and coding, consistently upgraded and optimized skill set, and healthcare IT-related services, is well equipped to extend professional support and consultancy services to healthcare providers.Browse our Revenue Cycle Management Consulting Services(http://www.medicalbillersandcoders.com/Consultancy_Services.aspx)

2012 is the year that health reform actually hits home and the healthcare providers need to put their house in order in terms of regulation compliances such as HIPAA 5010, ICD10, PQRI (Physician Quality Reporting Initiative), CPOE (Computerized Physician Order Entry), HIE (Health Information Exchange) along with the latest EHR updates.When deadlines are hovering over busy physicians, they do look out for external support to inculcate the dynamic changes. The MBC consultancy professionals can effortlessly implement and integrate these compliances into physician’ system. This can save the physicians immense administrative complications and inconvenience during the transition process as also after the regulation deadline.The MBC experts also believe that the regulation related changes are not complex per se; the challenge lies in actively motivating the physician's team to adopt these compliances by underlining their relevance and scope in effective patient healthcare and improved revenue cycle management.New York City Medical Billing, KANSAS CITY Medical BillingAbout Medicalbillersandcoders.comMedicalbillersandcoders.com is the largest 'Consortium of Medical Billers and Coders,' across the US. The portal brings together hundreds of billers, with experience in different specialties, on the same platform to service physicians in their local areas. This network of coders and billers is growing rapidly and is currently servicing over 50 specialty physicians, across the US (Iowa Medical Billing, New York Medical Billing, Ohio Medical Billing, Texas Medical Billing), with the most prominent being Cardiology Medical Billing, Mental Health Medical Billing, Dental Billing, Oncology Medical Billing, and General Practice.Contact :Prerna Gupta, Media Relations108 West, 13th street,Wilmington, DE 19801Tel : +1-888-357-3226Email : info@medicalbillersandcoders.comWebsite : http://www.medicalbillersandcoders.com/

Payment posting is one of the most important steps that can assist in improving a physician’s revenue if done efficiently. Although payment posting is becoming electronic and automated there is still the need for checking for accuracy and errors in the posting. There are numerous ways in which physicians can benefit from accurate and efficient payment posting and its analysis.

Explanation of Benefits (EOB)

The ability to carefully read and comprehend the EOB is one of the crucial aspects of medical payment posting. Avoiding errors in EOB or correcting the errors made by an insurance payer can lead to avoidance of long term financial loss. Studying and minutely examining the EOB for correct information such as the claim number, provider, type of service, the not covered amount, and insured ID number can drastically reduce mistakes and ensure that you are properly remunerated.

Electronic Remittance Advice (ERA)

ERA is provided by most insurance providers and is an electronic form of EOB or explanation of benefits. This helps in increasing your productivity and streamlining your workflow and can be integrated to your PMS. However, facts about underpayments, denials, multiple adjustments, cross-over’s, reversals, and secondary remittance have to be analyzed in order to ensure correct reimbursement in a timely manner.

Insurance Follow up

Correct payment posting also supports insurance follow up which ensures optimal revenues for physicians. Insurance companies can deny claims based on any type of error and it is important for billers and coders to keep in touch with such providers in order to ensure that the issue is being addressed. Therefore accurate payment posting can eliminate such delay in denied claims by avoiding errors. Payment posting sets the stage for effective Account Receivables follow up.

Reduce costs and tool to measure efficiency

The cost of billing can be reduced along with an increase in revenue due to better payment posting processes. The reduction in cost is also due to the time saved by electronically done payment posting which is verified by experienced billers and coders. Moreover Payment Posting is a key tool to measure the efficiency of Medical Billers and Coders as it stands testimony to clean claims and error free billing.

Quantitative advantages

The recent health reform is going to ensure more doctor-patient encounters and the sheer volume of EOB and the amount of posting would become staggering. This is where attention to detail while reading EOBs and familiarity and experience in advanced electronic remittance scenarios is important. Balancing receivables by accurate and timely Payment Posting, makes performance reports more clear and concise to draw financial decisions.

EOB or ERA, the human intervention in the analysis is inevitable; the best computing system cannot drive efficiency in collection all by them. Expert medical billers are required to scrutinize those customized reports. Medical Billing specialists at medicalbillersandcoders.com are experienced in such scenarios and keep updated about payment posting processes and also all other adjustment clauses in the reimbursement policy.

Denial management is one of the aspects that affect physicians, health care providers, insurance providers, and patients alike. The major problems faced by billers and coders along with patients are that the insurance companies or payers deny claims based on any reason they can find. This includes technicalities and some aspects such as pre-existing conditions or dropping people from insurance plans because they have an illness.

Insurance companies, being profit oriented, would ideally deny claims based on a genuine cause or even a small point. This loophole has been covered by steps such as allowing children to stay on parents medical policy till the age of 26 and reduced denials in case of pre-existing conditions. This aspect essentially means lesser grounds for claims denial for insurance companies and increased revenue for doctors and health care providers.

Furthermore, payer responsibilities increase with electronic transactions and insurance companies and payers cannot deny the fact that they never received the claim. Adding the healthcare IT reforms to this concoction makes a system that is efficient in face of such reforms. The Obama health reform plans to reduce insurance denials even while the doctor-patient encounters increase. This essentially means that the amount of revenue earned by physicians and health care providers is increasing and so is the need for efficient denial management by medical billers and coders. However, the amount of time required for the processing of denial management is also increasing along with the amount of time dedicated by health care providers.

Denial management has acquired a new dimension because of the health care IT reforms and the process is becoming faster and ethical at the same time. Moreover, HIPAA 5010 would also ensure all transactions are in the electronic format and help physicians track reasons for denials easily. This would ensure a steep drop in denials and a greater awareness for physicians in times of increasing work and decreasing reimbursements (proposed SGR cuts) for physicians and health care providing entities. With changing trends of healthcare, the economy hopes to see red tape is avoided in all sectors of health care including Medicare and Medicaid with insurance companies duly and perhaps ethically justifying the denied claims.

Managing claim denials require relationships with insurance companies as well as physicians along with communication skills and knowledge about various medical terminologies. Medical billers and coders who are experienced in this field can not only efficiently interact with insurance providers and manage denials but also keep up with health care IT reforms and comply with HIPAA guidelines.

Health care fraud and abuse is an important and conspicuous factor in the resource and finance drain in the US healthcare system and is responsible, to an extent, for the escalating healthcare costs.According to a report by Thomson Reuters on US healthcare spending, the US healthcare system wastes between $505 billion and $850 billion every year, out of which the waste caused due to Fraud and abuse constitutes $200 billion, or 22% of healthcare waste every year.The following chart shows the percentage of waste caused due to different parameters in the US healthcare spending.

Source: Healthcare analytics, Thomson Reuters

What is healthcare fraud and abuse? Health care fraud is a criminal act in which a consumer or physician(s) deliberately misrepresents facts or information, for the purpose of undeserved or greater reimbursement. Health care abuse is a reckless disregard or conduct that goes against and is inconsistent with acceptable business and/or medical practices resulting in greater reimbursement.

How to prevent it?Health care fraud and abuse has played such a vital role in increasing the cost of health care and has become a pertinent issue for the government as well as the general public.

The question is how to prevent it?Both Consumers and physicians have to be alert to the possibility of fraud and abuse and work to prevent it. Consumers need to get involved with their health care beyond the point of going to the doctor and taking medication. They need to be educated on their insurance plan, how much they pay, the proper names of their ailments, and they need to keep track of the services they receive and why they receive them. Simple tips that may help prevent fraud and abuse include:

Review Explanation of Benefits to ensure accurate dates of service, name of providers, and types of services reported

Protect insurance card and personal information at all times

Count pills each time they pick up a prescription

Research providers with state's medical boards

Report suspected fraud and abuse as soon as possible

Along with consumers, physicians too must check for any unintentional fraud and abuse happening around them. They can have training and awareness amongst their staff to prevent unintentional fraud. These joint efforts would definitely check the fraud and abuse rate in the United States and ultimately bring down the overall cost of healthcare.

Commercial health insurance has registered an increase of 2% over the existing average claims processing error rate of 19.3%. This 2% translates to an extra 3.6 million in erroneous claim payments, and costs an additional estimated $1.5 billion in highly avoidable administrative costs to the health system.

AMA (American Medical Association) has released its Fourth Annual National Health Insurer Report Card which underscores the 2% increase in inaccurate claim payments since last year among the leading commercial health insurers. Claims-processing errors by health insurance companies squander billions of hard-earned dollars, frustrating general public as well as physicians in the process. The AMA estimates that eliminating health insurer claim payment errors would save $ 17 Billion.

The key findings of this report are as follows :

Performance: United Healthcare emerged as the only commercial health insurers with an accuracy rating of 90.23% while Anthem Blue Cross Blue shield scored the worst with an accuracy rating of 61.05% according to the report.

Denials: A noticeable reduction in denial rates has occurred since last year at Aetna, Health Care Service Corporation and United Healthcare, which reduced its denial rate by half to 1.05%. CIGNA maintained its industry low denial rate of 0.68%. The common reason for denials continues to be the absence of patient eligibility for medical services.

Non-payment from Insurers: nearly 23% of claims submitted by physicians in 2010 received no payment at all from the commercial health insurers. One of the most frequent reasons cited by insurers was deductible requirements that shift payment responsibility to patients until a dollar limit is exceeded.

Administrative requirements: The report has also mentioned how frequently claims included information on insurers requiring physicians to ask permission before performing a treatment or service. A recent AMA survey of physicians indicated that insurer’s requirements to preauthorize care delayed or interrupted medical services, consumed significant amounts of time and complicated medical decisions.

Analyzing the various facts highlighted in the report, it appears likely that physicians would continue to experience roadblocks in reimbursement for their payments. In order to streamline the process of reimbursement, they would have to rely on experts who are well versed and experienced enough to pre-empt the loopholes and grey areas in the payer system and avoid falling prey to those. Physicians and healthcare organizations facing obstinate rates of non-payment and/or denials do not have to take it lying down; they can take the help of qualified professionals from medicalbillersandcoders.com to experience error-free claims filing to ensure a healthy reimbursement rate.

2010 registered a positive trend in terms of increased income for primary care physicians in the US. The increase in income varies according to the specialties i.e. some specialties saw a modest increase in income while others saw a more pertinent rise. The factors which are responsible for these changes in the income vary from the kind of specialty, the reimbursement rate and, to some extent, the location of the physicians. However, at the same time the income has declined to an extent in the case of some specialties. These key findings have been highlighted by survey based on almost 60,000 physicians across 110 specialties in the United States and conducted by Medical Group Management Association (MGMA)

Let's have a look at how the physicians income has changed in the year 2010

Primary care physicians saw a modest increase of 2.94% in their compensation from 2009 while internists and pediatricians saw their income rise by 4.21% and 0.39% respectively. Dermatologist saw the highest increase in their income at 12.2%, a recurrent feature over the years, probably due in part to their ability to offer elective procedures not routinely included in insurance and secure the complete fee at the time of service.

Ophthalmologists, with a hike of 7.7% are apparently cashing in on the rising popularity of laser refractive surgery and other non-covered services. On the other hand, some specialties such as anesthesiologists, gastroenterologists, obstetricians/gynecologists, invasive cardiology, diagnostic radiologists, and urologists registered a decline in their compensation. In Hematology/oncology the income remained flat, with only a 2.2 percent increase since 2005, due in part to diminished reimbursement for administering drugs.

Location desirability is another factor influencing competition and compensation. According to the survey, physicians practicing in the south reported the highest median earnings, at $216,170 in primary care and $404,000 in specialty care. They were followed by physicians in the Midwest and west. Physicians in the East earned the least, at $194,409 in primary care and $305,575 in specialty care. The key findings could help in focusing the physicians attention on improving their billing and coding operations among other things in order to boost their reimbursement rates and look around for more professional help in the area.

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Medical Billers and Coders is the largest consortium of Medical Billers and Coders in the United States. Our aim is to help the physician community to reach the right expertise in the right location at the right time.